vision loss Flashcards
transient loss of vision in one eyecausedby
transient ischemic attack caused by platelet thrombin emboli from atheromatous plaques in carotid artery on same side –> AMAUROSIS FUGAX
what causes transient loss of vision in both eyes?
Basilar artery insufficiency
short lived (a few seconds) loss of vision caused in one eye by?
papilledema
casues of painful loss of vision (4)
optic neuritis
acute narrow glaucoma
uveitis
endopthalmitis
painless loss of vision (3)
cataracts
central retinal artery or vein occlusion
retinal detachment
sudden loss of visison in one eye adult? kids?
adults - vascular (HTN, diabetes, etc)
kids - optic neuritis R/O demyelinating disease
if bilateral nonreactive pupils discovered, what shoudl you test?
near reflex (accomodiation, miosis, constriction) (could be argyl robinson pupil - neurosyph)
vision loss caused by lesion posterior to the exit of the pupillary fibers will not be associated with abnormalities of ___________
pupillary reflex
presence of relative afferent pupillary defect usually associated with _______
diseases of optic nerve, chiasm or optic tract anterior to the exit of pupillary fibers and arterial or venous occlusive diseases
pts w/retrobulbar optic neuritis have a positive _______ even though their optic disc looks normal
relative afferent pupillary defect
which test - move light straight back from one pupil to the other and go back several times
relative afferent pupillary defect (RAPD) test. tests for marcus gunn pupil =afferent pupillary defect
do not expect to find what if confrontation visual field testing?
subtle VF defects (how to do test. have pt cover left eye and look directly at your left eye w/their uncovered right eye)
visual field: retinal or optic nerve lesion lesion produces
central scotoma (retinalvsualr lesions usually respect horizontal midline)
chiasmal compression produces:
bitemporal hemianopsia
lesions behind chiasm produce
congrous HH - occipital cortex
incongroups HH - more anterior
describes what :
- usually occcurs in young, middle aged adults
- sudden loss of vision inone eye
may have pain on motion of eye
AFFERENT PUPILLARY DEFECT PRESENT
CENTRAL VISUAL FIELD DEFECT (pt cannot see object when look directly at it, but can see it when look to side)
COLOR DESATURATION IN AFFECTED EYE
DISC NORMAL OR SWOLLEN
OPTIC NEURITIS
what is a centrocecal scotoma (eg found in optic neuritis)
central scotoma that connects w/physiologic blind spot
disc in REtrobulbar Optic neuritis?
disc in papillitis?
vision loss for how long in optic neuritis?
when does vision improve?
prognosis for return to vision?
tx?
retrobulbar - optic disc normal
papillitis - optic disc swollen
vision loss over 10-14 days
improves over 3+ weeks
prognosis for vision to return = >90%
tx: IV corticosteroids
* papillitis vs. pailledema*
disc inolvement?
RAPD?
visual acuity?
scotoma?
papillitis: ONE disc, +RAPD, DECREASED visual acuity, CENTRAL scotoma
papilledema: BOTH discs, -RAPD, NORMAL visual acuity, ENLARGED physiologic blind spot
sigificance of optic neuritis?
Maybe presenting complaint of MULTIPLE SCLEROSIS!!!!
chiams lesions:
how is VA?
is bitemporal hemianopsia symmetric/optic atrophy?
MC cause?
other causes (3)
VA reduced in one or both eyes
bitemporal hemianopsia and optic atrophy- asymmetric (usually w/ eye with RAPD in eye w/poor vision w/pale optic disc (atrophic)
MC cause: pitutiary adenoma
others: meningitioma,craniopharyngioma,aneurysm
lesion btw chiasm and LGB produce
optic atrophy and RAPD
lesions posterior to LGB produce
normal pupil and normal RAPD, NO Optic atrophy.
post chiasmal lesiosn produce?
homonymous hemianopsia
in a homonymous hemianopsia, congrous, what owuld you be worried about in old pt?
stroek in old; tumor in young pt.
normal optic disc:
what should you check for?
4Cs + 2 more
color
contour
circumference(margins)
cup size
spontaneous venous pulsations
retina/vessels
what is a bilateral swelling of the optic discs secondary to increased intracranial pressure? which two conditions must be ruled out?
papilledema.
RULE OUT: pseudotumor cerebri and BRAIN TUMOR.
what is seen with:
normal visual acuity
visual field full w/enlarged blind spot
no pain on eye movement
no RAPD
Headaches, nausea, and vomiting
+/- CN6 palsy
papilledema
signs inlcude:
both discs elevated and hyperemic
disc margins blurred, indistinct,
small vessel margin obscured
retinar vessels tortous, dilated
hemorrhages and exudates
spontaneous venous pulsations absent
signs of papilledema.
what is described below:
acute loss of vision in one eye in older pt
AFFERENT PUPILLARY DEFECT PRESENT
DISC SWOLLEN and PALE
ISCHEMIA of DISC(small vessel occlusion)
altitudinal hemianopsia common
what must you rule out?
ISCHEMIC OPTIC NEUROPATHY
must R/O temporal arteritis
what is seen with
pale retina w/central aretry occlusion secondary to ischemia
pale optic disc
narrowed arterioles
cherry red macula
R/O temporal areritis
central retinal artery occlusion
what is seen with:
hemorrhagic infarct of retina
swollen, hypereremic disc + venous distention
flame shaped _ other hemorrhages
seen in pt w/diabetes, chornic open angle glaucoma,
blood disease that Increases viscosity of blood:PCV and multiple myeloma.
central retinal vein occlusion
ocular disease associated with: increased intraocular pressure, damaged optic nerve, characterized by ENLARGEMENT OF optic Cup and eventual pallor
-ealry visual field loss (ASYMPTOMATIC)
LOSS OF CENTRAL VISION -LATE
CHRONIC OPEN ANGLE GLAUCOMA
SUGGESTED BY PALE COLOR OF ATROPHY
USUALLY POOR VISION AND VISUAL FIELD
MAY BE CAUSED BY LESION IN RETINA, OPTIC NERVE, CHIASM, OR OPTIC DISC
ATROPHY WITH LARGE OPTIC DISC CUPS- USUALLY GLAUCOMA
OPTIC ATROPHY
